Treatment Options for Chronic Gastritis with Bile Reflux

Understanding the Mechanism of Bile Reflux in Chronic Gastritis

From a physiological perspective, bile reflux often occurs due to the relaxation of the pyloric sphincter. The pylorus is the gateway between the stomach and the duodenum. When this muscular ring becomes weak or relaxed, bile from the bile ducts can flow backward into the stomach during intestinal contractions. This reverse movement, known as retroperistalsis, allows bile to enter the gastric environment where it doesn't normally belong.

Diagnostic Indicators Seen During Endoscopy

During a gastroscopy, one key sign of bile reflux is a discolored mucus pool in the gastric fundus — typically appearing yellowish rather than clear. In more advanced cases, the gastric mucosa itself may show signs of yellow staining due to prolonged exposure to bile acids. These findings support the diagnosis of chronic superficial gastritis accompanied by bile reflux.

Differences in Treatment Approach

The treatment strategy for this condition differs from that of erosive gastritis. The primary goal is to manage the abnormal retroperistaltic movement and reduce bile irritation in the stomach. A dual-therapy approach is commonly recommended: prokinetic agents to enhance gastrointestinal motility and bile acid sequestrants to absorb excess bile acids.

Optimal Timing for Medication Intake

For best results, prokinetic medications should be taken approximately 30–40 minutes before meals. This timing allows the drug to act when the digestive system is most active, helping to regulate peristalsis and prevent bile from flowing back into the stomach.

Important Considerations for Drug Safety

Commonly used prokinetics such as domperidone (Motilium) and cisapride (Prepulsin) have been associated with cardiac side effects, particularly QT interval prolongation. Patients with existing heart rhythm disorders should avoid these medications, as they can trigger life-threatening arrhythmias. Therefore, it's crucial to follow the guidance of a specialist when selecting and dosing these drugs.

In conclusion, managing chronic gastritis with bile reflux requires a targeted and cautious approach, combining both motility regulation and bile control under professional supervision.